Spotlight: Formulas for Dysuria

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Bi Xie Fen Qing Yin
Qian Lie Xian Wan
Jie Jie Wan
Ba Zheng Wan

In the modern hospital approach Traditional Chinese Medicine, difficulties with urination are included in lin zhong (Urinary Disturbance) long bi (Retention of Urine) and gao lin (Painful Urinary Dribbling). Symptoms include frequency of urination, difficulty starting or stopping the stream and urgency to urinate. It can also include a bearing down sensation in the inguinal or bladder area. In some cases, urination is accompanied by a burning sensation or pain. These symptoms can be attributed to weak bladder, swollen prostate or an active infection of the bladder or prostate. In Chinese medicine, these disturbances are divided into deficiency and excess presentations.

In deficiency, most cases are due to a deficiency of kidney yang. As people age, we also find a diminishment of mingmen fire and jing (sexual essence). While the primary symptoms are urinary dribbling or urgency, they may also include lowered sexual desire or function, cold limbs, sore lower back, or swollen prostate. Several of these formulas are useful for children´s enuresis (bedwetting) when due to a weak kidney yang.

Cases of urinary difficulty due to excess are usually seen in swelling of the prostate, acute infection of the prostate, and urinary tract infection. In benign swollen prostate, we see a complex pattern of deficiency of qi or yang with accumulation of dampness or blood stagnation. Acute infections of the prostate or bladder often involve swelling, but pathogenic heat-toxins are in play and need to be addressed.

There are several formulas that address different patterns related to Urinary Difficulty.

BI XIE FEN QING WAN

The formula´s name translates as "Dioscorea Bi Xie Separate (the) Clear Pills". Its origin is in "Yang Family Depository of Formulas" (yang shi jia zang fang) written by Yang Tan in 1178. A common version of the formula contains the following herbs and percentages:

bi xie (Rhizoma Dioscoreae Hypoglaucae) 48.5 %

gan cao (Radix Glycyrrhizae) 24.2

wu yao (Radix Linderae) 12.1

shi chang pu (Rhizoma Acori) 9.1

yi zhi ren (Fructus Alpiniae Oxyphyllae) 6.1

Traditional indications are to warm and benefit the kidney, dispel damp and turbidity, and to stop pain. It is used for frequent or painful urination with cloudy urine, difficulty starting or stopping the stream, urinary dribbling, and a distended sensation in the lower abdomen. It can be used in chronic prostatitis, chronic cystitis, and early-stage kidney disease. It can also be used in leukorrhea (vaginal discharge) due to cold.

This is an effective remedy for urinary difficulty or dribbling due to deficiency-cold kidney patterns. It is not appropriate for damp-heat conditions or infections. Zhu Danxi (1481) indicated that the urine of the patient would be "white as rice soup and thick as dilute paste," what we refer to as cloudy urine. In the Herbal Times version we find a high amount of bi xie, over 48%. This resolves turbid dampness, and can also reduce pain due to turbid dampness. It is a neutral herb in terms of temperature (energy) but here it is combined with yi zhi ren and wu yao, both warming herbs. When kidney yang is thus replenished, it allows turbid dampness to be excreted. Shi chang pu helps transform turbid urine to clear and also warms the bladder. This version adds a large amount of gan cao, which will reinforce spleen qi to counteract accumulation of dampness.

This condition is usually seen in older men. It can be given alone or combined with a good kidney yang tonic such as You Gui Wan, Huan Shao Wan, Du Zhong Bu Tian Wan or Wu Zi Yan Zong Wan.

QIAN LIE XIAN WAN

This formula is based on a modern Chinese patent medicine, developed for its clinical effectiveness. Its name can translate as "Prostate Gland Pills" or "Prostatitis Pills". The formula is:

huang qi (Radix Astragli) 17 %

bi li (Fructus Ficus Pumilae) 15

huang bai (Cortex Phellodendri) 13

liang tou jian (Rhizoma Anemones Raddeanae) 13

pu gong ying (Herba Taraxaci) 13

ze lan (Herba Lycopi) 13

che qian zi (Semen Plantaginis) 10

hu po (Succinum) 6

In terms of TCM, the formula clears heat, resolves toxins, dispels damp, invigorates blood, tonifies qi, dissipates masses, stops pain. It is used for acute or chronic prostate infection, with symptoms of swelling, painful urination, urinary pus, urinary dribbling or retention, distended sensation in the lower abdomen or testicular pain. The pulse is thin, wiry, occasionally rapid and the tongue will be either normal or show redness.

The formula includes herbs to dispel dampness and swelling, combined with herbs to clear heat and resolve toxin. One of the main herbs is bi li, not well known or commonly used. This is the fruit of Ficus pumila, and it is used to tonify the kidney, astringe discharge and reduce swelling. Ze lan helps promote urination, and is useful for reducing swelling with pain. It is reinforced by che qian zi to drain dampness, and hu po to relieve swelling. Huang bai and pu gong ying are used to clear heat and resolve toxin. The unusual herb liang tou jian reduces swelling by resolving phlegm and is also used for infectious abscesses. Huang qi promotes wei qi to help resolve infection.

This formula is best used for chronic prostate infection with swelling and pain, but may is also helpful for prostatic hyperplasia without signs of heat or infection. It should also be considered for chronic urinary tract infections unresponsive to Ba Zheng Wan. Conversely, in acute prostatitis, one can combine Qian Lie Xian Wan with Ba Zheng Wan.

JIE JIE WAN

This is a unique formula. It follows the same name and indications of Kai Kit Pills, a patent medicine produced by Hanyang Pharmaceutical Works, but with a different prescription. Jie Jie Wan translates as "Resolve Swelling Pill". The formula is:

shi wei (Folium Pyrrosiae) 27 %

jin qian cao (Herba Lysimachiae) 23

huang qi (Radix Astragli) 7

e zhu (Rhizoma Curcumae) 7

san leng (Rhizoma Sparganii) 7

tong cao (Medulla Tetrapanacis) 7

da huang (Radix et Rhizoma Rhei) 4

tu xiang ru (Herba Origani Vulgare) 4

che qian zi (Semen Plantaginis) 4

yan hu suo (Rhizoma Corydalis) 4

hai jin sha (Spora Lygodii) 4

gan cao (Radix Glycyrrhizae) 2

TCM indications are: clears heat, resolves toxins, frees and benefits the movement of urine, invigorates blood, tonifies qi, stops pain. It is used for swollen prostate with signs of infection, including dribbling, burning or painful urination, downward bearing distension of pain in the inguinal area, and difficulty in urination. It can also be used for testicular pain due to heat. The pulse may be thin, wiry and rapid. The tongue is normal, or slightly red.

The lead herbs, shi wei and jin qian cao, make up 50% of the formula, and together they aggressively clear damp-heat while promoting urination. The formula is reinforced with herbs to move blood and break blood stasis, including e zhu and san leng, which helps reduce swelling. Tu xiang ru is the leaf of the oregano plant, and is used to clear heat-toxin. This effect is reinforced with da huang. Hai jin sha is used for treating painful urination due to damp-heat. Tong cao and che qian zi promote the draining of dampness. Herbs that reduce swelling by invigorating the blood or breaking blood stasis include e zhu and san leng. Huang qi boots the wei qi to help support the immune system.

Between Jie Jie Wan and Qian Lie Xian Wan, this formula is better for acute prostatitis with burning urination while Qian Lie XianWan is better for chronic prostatitis.

BA ZHENG WAN

This formula is well known as the formula of choice for an acute bladder infection, but is also useful for urinary disturbance due to damp-heat. The name translates as "Eight Righteous (Ingredients) Pills" (it contains nine herbs). It is attributed to Chen Shi-Wen in 1080, and was recorded in the tai ping hui min he ji ju fang, 1107. The formula consists of:

hua shi (Talcum) 18 %

zhi zi (Fructus Gardeniae) 11

che qian zi (Semen Plantaginis) 11

deng xin cao (Medulla Junci) 11

bian xu (Herba Polygoni Avicularis) 11

qu mai (Herba Dianthi) 11

tong cao (Medulla Tetrapanacis) 11

zhi gan cao (Radix Glycyrrhizae Preparata) 8

da huang (Radix et Rhizoma Rhei) 8

The TCM indications are: clears heat, dispels damp, benefits the movement of urine, relieves pain. Symptoms can include dark, turbid or bloody urine, pain during urination, scanty or frequent urination, and lower back pain. Besides UTIs, this formula is useful in acute prostatitis, early kidney infection, glomerulonephritis, and postoperative or post-illness urine retention when there are signs of damp-heat. The pulse is slippery and rapid, and the tongue has a yellow, greasy coat.

All of the herbs used are quite cold, and directed towards clearing damp-heat in the bladder. The two lead herbs are bian xu and qu mai, which direct the formula to the bladder and kidney and clear damp-heat. This is one of the few antibacterial formulas that does not rely on berberine herbs such as huang lian or huang qin, etc, although zhi zi and da huang are included. This formula is too cold for cases of "bladder infection" not due to damp-heat, but they may respond to a formula such as Qian Lie Xian Wan, above.

Ba Zheng Wan is not recommended for long-term use or for weak patients; the cold nature of the herbs can injure yang and qi. If the symptoms are not relieved in 36 hours, consider Western antibiotics. The use of this product is prohibited during pregnancy, due to the inclusion of da huang.

Conclusion

Frequent urination, urinary dribbling, or painful urination are common presentations. The practitioner should distinguish excess from deficiency, and heat from cold. The four formulas discussed here can address a number of the presentations. Once again, it is important to point out that correct use of Chinese herbal formulas ultimately rely on the practitioner´s familiarity with the materia medica. When one is choosing a formula, and one is uncertain of a specific ingredient, it´s important to take the time to look at the various reference works. For me, I most frequently refer to John and Tina Chen´s Chinese Medical Herbology and Pharmacology, and Bensky´s Chinese Herbal Medicine Materia Medica, 3rd Edition. Ironically, these sources did not contain any information of the herbs bi li (Fructus Ficus Pumilae), liang tou jian (Rhizoma Anemones Raddeanae), or tu xiang ru (Herba Origani Vulgare). For these more obscure herbs, I use Hsu et al, Oriental Materia Medica, A Concise Guide, 1986.

Jake Paul Fratkin, OMD, L.Ac. has been in practice since 1978. He is the author of Chinese Herbal Patent Medicines, The Clinical Desk Reference, a compendium of 1250 Chinese herbal products available in the United States, and the editor-organizer of Wu and Fischer´s Practical Therapeutics of Traditional Chinese Medicine, Paradigm Publications, 1997. He is the recipient of ACUPUNCTURIST OF THE YEAR, 1999, by the AAAOM and TEACHER OF THE YEAR, 2006, American Association of Teachers of Acupuncture and Oriental Medicine (AATAOM). He lives and practices in Boulder, Colorado.